Patient-generated health data (PGHD) can provide both patients and physicians with a reliable tool to support the management of type 2 diabetes. These data may include glucose level, blood pressure, medication intake. , food and water consumption, and more. However, this article will focus on blood glucose, as patients with diabetes are more motivated to measure it regularly.
Practically, these measures serve patients only for self-management, while providers can collect PGHD, analyze it, and achieve better health outcomes. Let’s review some of them.
3 clinical results of the appropriate use of PGHD
Permanent control over a patient’s vital elements, in our case glucose, can offer caregivers the following benefits:
Timely updates of the treatment plan
Because patients ’health status is constantly changing, providers need to have real information about theirs chronic disease management course and make 100% sure that the current treatment plan works. The reasons for changing the treatment plan can be adjusted to:
- Lifestyle changes (relocation, new physical activities or others)
- Changes in the patient’s body (increased insulin resistance, decreased insulin secretion in beta cells, infection)
- Influence of parallel treatment (for example, if the patient takes sulfonamides affecting the absorption, transport, metabolism and elimination of SU derivatives)
An increase in glucose level or increases in glucose may indicate that treatment should be changed.
Identification of negative trends
Diabetes is a lifelong disease, so the continuous measurement and processing of blood glucose data can determine both negative and positive trends in a patient’s health status. If your glucose level rises slowly without changes in your treatment plan, hydration, nutrition, and physical activity, a doctor can recognize negative patterns and determine the triggers as soon as possible.
For example, not all patients with type 2 diabetes require insulin therapy, as about 40% can treat their condition with an oral antidiabetic agent. Thus, if the patient only takes oral medications, this long-lasting, progressive hyperglycemia may demonstrate that day-to-day treatment does not help the patient effectively. In this case, the doctor may change a medication, prescribe additional insulin therapy to supplement or even replace the oral drug.
Last but not least, it is a more effective patient engagement and motivation.
If a patient does not share the measured glucose levels with their caregiver, why should they keep a record? During the appointment, a patient will, at best, offer their doctors to check some recent measurements, daily or weekly.
On the other hand, if a patient knows that each new number will be recorded and analyzed in order to accurately treat diabetes, he is motivated to measure his blood glucose more often and write it down regularly.
In addition, PGHD helps motivate a patient for more systematic care. If recent measurements reveal the need for an appointment or HbA1c test to assess the general trend, the patient may be notified of this need, possibly automatically.
Overcoming PGHD skepticism
Every idea should address healthy doubts, so we also have some to review.
There is a lot of noise in PGHD (e.g., incorrect calibration, irregular measurements) and it is a reason to be skeptical about clinical outcomes. However, raw data is often foggy and a bit messy before processing. We can rely on technology to clean it up and prepare us for further analysis. In addition, a physician uses PGHD knowledge for the preliminary assessment of a patient’s health status, so it is always possible and even desirable to refer him to a laboratory for a more detailed picture. of the condition (if a patient takes an HbA1c test).
The patient can handle PGHD without a doctor
Of course, patients can and should control their blood glucose, but we must also remember the nature of the human mind. Our psychology works 24 hours a day to defend us from emotional trauma, and a chronic illness could end up being on the list of traumatic experiences. Consequently, some patients may completely give up blood glucose control, thinking that healthy behavior causes the disease to go away permanently.
In addition, patients are not certified health specialists (well, not all, at least) trained to objectively identify negative trends and change their treatment plans accordingly.
Basic concepts of PGHD implementation
Where to store data
I’m sorry, EHR, you’re out. Even if we only talk about blood glucose inputs, the volume of data is too massive to store within the EHR. We suggest integrating independent storage that can collect and store PGHD for years. Reports can be entered into the EHR as virtual tests, where not all measurements are recorded but a summary (increases of up to 220 mg / dL in April or a trend of glucose level growth of 2-5 mg / dL per month).
How to analyze it
To ensure in-depth analysis, we need to consider old and new technologies. Some of the continuous glucose monitors (CGM) and instant finger prick tests can connect to a patient’s mobile device using a specific application. However, when a patient’s insurance only covers cheaper or older meters, this connection is no longer an option. In this case, a mobile app can also be an outlet, as a person can manually enter their numbers and share them with a caregiver.
Now, if we have a monthly set of measurements of a patient, we can already obtain the following knowledge:
- Trends can show whether the patient’s condition worsens or improves using the statistically calculated regression function displayed as an ascending or descending graph
- Empty belong to noise, however, they may indicate a patient’s negligent attitude toward glucose control
- Waves show glucose spikes and highlight if a patient is consuming too much sugar or carbohydrates, ignoring nutritional recommendations
- Decline they are even more important than waves, as they mark a high risk of hypoglycemia, which is especially dangerous during the hours of sleep.
Activation of notifications
No one expects a doctor to study tons of PGHD records and draw conclusions. Instead, the technology is here to notify a doctor and / or patient in predefined cases (as illustrated in this online demonstration).
For example, if the trend chart is upward, a doctor may receive a notification about it. If there are several gaps in the measurements, a patient may receive a reminder to check and enter their numbers. Technically, notifications can reach their recipients through push notifications from mobile apps, emails, text messages, and other communication channels.
Wow, what a trip. What we mean by this epilogue is that PGHD is the kind of data you’ve spread across thousands of devices from diverse patients. Of course, this information needs efforts to gather, clean, analyze, and distribute.
However, ignoring the possibility of using PGHD means ignoring the opportunity to improve care for diabetes. You can help patients with diabetes stay in the area of normal blood glucose numbers and never experience complications or exacerbations. So let’s do it and help them as best we can.